Pitolisant,a selective histamine H3 re-ceptor inverse agonist,promotes wakefulness by blocking H3 autoreceptor-mediated feedback inhi-bition to elevate central histamine levels.It is clini-cally indicated for wake promotion in narcolepsy.The development journey of pitolisant spans over two decades,encompassing extensive preclinical and clinical research.These studies have demon-strated both sustained efficacy in managing narco-lepsy and a favorable long-term safety profile.No-tably,pitolisant received formal marketing authori-zation from China's National Medical Products Ad-ministration(NMPA)for treating excessive daytime sleepiness or cataplexy in adult narcolepsy pa-tients.This approval addresses an unmet medical need in China's therapeutic landscape,providing patients with a safe,effective,and well-tolerated novel therapeutic option.This article will summa-rize the basic and clinical research progress of pi-tolisant from the aspects of development history,preclinical studies and pharmacological effects,clin-ical research and indications,medication guide-lines,and safety,aiming to provide a scientific basis for the clinical treatment of narcolepsy.

Rapid eye movement sleep behavior disorder（RBD）， as a sleep disorder with unique clinical manifestations， is currently widely regarded as a precursor marker for α-synucleinopathies （Parkinson disease， dementia with Lewy bodies， and multiple system atrophy）. In recent years， great achievements have been made in radiological studies on isolated RBD and RBD comorbid with various α-synucleinopathies. This article reviews the research findings in RBD in terms of magnetic resonance imaging and radionuclide imaging and discusses the significance of radiological features in the diagnosis and prognosis of RBD， so as to provide a reference for subsequent research and clinical practice.

Pitolisant,a selective histamine H3 re-ceptor inverse agonist,promotes wakefulness by blocking H3 autoreceptor-mediated feedback inhi-bition to elevate central histamine levels.It is clini-cally indicated for wake promotion in narcolepsy.The development journey of pitolisant spans over two decades,encompassing extensive preclinical and clinical research.These studies have demon-strated both sustained efficacy in managing narco-lepsy and a favorable long-term safety profile.No-tably,pitolisant received formal marketing authori-zation from China's National Medical Products Ad-ministration(NMPA)for treating excessive daytime sleepiness or cataplexy in adult narcolepsy pa-tients.This approval addresses an unmet medical need in China's therapeutic landscape,providing patients with a safe,effective,and well-tolerated novel therapeutic option.This article will summa-rize the basic and clinical research progress of pi-tolisant from the aspects of development history,preclinical studies and pharmacological effects,clin-ical research and indications,medication guide-lines,and safety,aiming to provide a scientific basis for the clinical treatment of narcolepsy.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective To identify core genes of Alzheimer's disease (AD) through bioinformatic analysis and explore potential pathogenic signaling pathways. Methods Gene expression profiling data related to AD were downloaded from the Gene Expression Omnibus (GEO) database, with datasets GSE227221 and GSE162873 selected for analysis. GEO2R online analysis software was applied to screen differentially expressed genes (DEGs) between AD tissue samples and normal brain tissue samples. The Disease Ontology (DO) enrichment analysis of DEGs was performed using the DOSE package in R software, while Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted through the online data analysis tool DAVID. Protein-protein interactions (PPI) among genes were analyzed using the STRING database, and a PPI network was constructed with Cytoscape software. Hub genes within the PPI network were identified and screened using the MCODE plugin. Based on MCODE scores, further analysis was conducted to select core genes. Results A total of 1, 373 DEGs with consistent expression trends involved in the onset and progression of AD were identified from the two datasets, with the core genes of GIMAP genes (including GIMAP1, GIMAP4, GIMAP5, GIMAP6, GIMAP7, and GIMAP1-GIMAP5). DO enrichment analysis revealed the strongest associations between DEGs and three diseases: systemic lupus erythematosus, lupus erythematosus, and atherosclerosis. GO functional enrichment analysis indicated that DEGs were primarily enriched in three signaling pathways: the classical Wnt signaling pathway, phospholipase C-activated G protein-coupled receptor pathway, and plasma membrane lateral domain pathway. KEGG pathway enrichment analysis showed that DEGs were primarily enriched in pathways such as cytokine-cytokine receptor interaction, neuroactive ligand-receptor interaction, and cancer-related transcriptional dysregulation. Conclusion The core pathogenic gene of AD may be the GIMAP gene, and the associated pathways are complex, potentially implicating immune dysfunction.

Objective The efficacy and safety of pitolisant in the treatment of adult narcolepsy have been confirmed in clinical trials abroad， but there is a lack of data on the application of pitolisant in Chinese patients. The aim of this study is to investigate the efficacy and safety of pitolisant in the treatment of adult narcolepsy in China.Methods A total of 30 subjects were enrolled in this study and were given individualized titration once a day for 8 weeks. Epworth Somnolence Scale （EES） and daily cataplexy rate （DCR） were used as the primary outcome measures，and Clinical Global Impression-Severity scale（CGI-S） and Clinical Global Impression of Change Scale （CGI-C） were used as the secondary outcome measures；safety indicators included adverse event （AE） records and laboratory examination.Results The results showed that there were significant improvements in ESS score and number of cataplexy attacks after medication. At the end of treatment，ESS score was reduced by（7.63±4.79）（P<0.001）. For all subjects， the average daily number of cataplexy attacks was 0.83 at baseline，which was reduced significantly to （0.39±0.82）after 3 weeks of pitolisant treatment and（0.38±0.79）after 5 weeks of pitolisant treatment（P<0.05）. After the treatment ended， the median CGI-S score of excessive daytime sleepiness （EDS） improved from "severe" at baseline to "mild"（P<0.001）， and the CGI-S score of cataplexy improved from "mild" at baseline to "basically normal"（P<0.001）. Most AEs were mild and did not receive any drug treatment， and there were no significant changes in other laboratory markers used to monitor the general condition of the subjects before and after treatment. Conclusion Pitolisant has good efficacy and safety in the treatment of EDS and cataplexy in Chinese adults with narcolepsy.
Narcolepsy ; Histamine ; Cataplexy

Objective:To analyze the monitoring results of iodine deficiency disorders in Nanning City in 2020, learn about the consumption of iodized salt among residents and the iodine nutrition status of key populations, and provide scientific basis for formulating or adjusting targeted prevention and control measures of iodine deficiency disorders.Methods:According to the Guangxi Iodine Deficiency Disorders Monitoring Plan, monitoring was carried out in all of 12 districts (counties) in Nanning City. One township (street) was selected from each of the five directions of east, west, south, north, and central. Forty non-boarding children aged 8 to 10 and 20 pregnant women were selected as monitoring subjects in each township (street). Edible salt samples were collected from children and pregnant women to detect salt iodine content, random mid-course urine samples from children and morning urine samples from pregnant women were collected to detect urinary iodine content; in addition, thyroid examination of children was conducted in Qingxiu District, Liangqing District, Long an County and Shanglin County.Results:In 2020, a total of 2 434 children aged 8 to 10 and 1 207 pregnant women were surveyed in Nanning City. The coverage rate of iodized salt, the qualified rate of iodized salt and the qualified iodine salt consumption rate were 99.67%(3 629/3 641), 97.99%(3 556/3 629) and 97.67%(3 556/3 641), respectively. The median urinary iodine of children was 182.0 μg/L, and the median values ranged from 146.5 to 234.8 μg/L in different districts (counties), there were significant differences in median urinary iodine between urban and non-urban areas, different gender and age groups ( U = 2.38, 2.41, P = 0.017, 0.016; H = 16.42, P < 0.001). The goiter rate of children was 0.99%(8/807), and the rate ranged from 0 to 2.00% (4/200) in the 4 districts (counties) examined, there were significant differences in thyroid volume between urban and non-urban areas and different ages ( U = - 3.52, P < 0.001; H = 47.67, P < 0.001). The median urinary iodine of pregnant women was 191.0 μg/L. The median urinary iodine of different districts (counties) ranged from 141.0 to 241.5 μg/L, and the difference was statistically significant at different gestational stages ( H = 24.37, P < 0.001). Conclusion:In 2020, the coverage rate of iodized salt, the qualified rate of iodized salt and the qualified iodine salt consumption rate by residents in Nanning City are high, and the iodine nutrition of both children and pregnant women are at an appropriate level.

Background: and Purpose Collateral circulation is considered an important factor affecting the risk of stroke, but the factors that affect collateral circulation remain unclear. This study was performed to identify the factors associated with collateral circulation, especially blood lipids. Methods: The study involved patients who had undergone digital subtraction angiography and were confirmed as having severe unilateral stenosis or occlusion of the internal carotid artery (ICA). We classified the collateral circulation status of each patient as good (Grade 3 or 4) or poor (Grade 0, 1, or 2) according to the grading system of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology. We collected data on patients’ characteristics and identified the factors that affect collateral circulation. Results: This study included 212 patients. The multivariate logistic regression analysis showed that the high-density lipoprotein cholesterol (HDL-C) concentration and a complete anterior half of the circle of Willis were independent protective factors for good collateral circulation, whereas elevated lipoprotein(a) [Lp(a)] and serum creatinine concentrations were independent risk factors for good collateral circulation. The area under the receiver operating characteristics curve (AUC) was 0.68 (95% confidence interval [CI], 0.61–0.76) for HDL-C and 0.69 (95% CI, 0.62–0.76) for Lp(a). A binary logistic regression model analysis of the joint factor of HDL-C and Lp(a) yielded an AUC of 0.77 (95% CI, 0.71–0.84). Conclusions In patients with severe unilateral ICA stenosis or occlusion, the combination of HDL-C and Lp(a) is a useful predictor of collateral circulation.

Rapid eye movement sleep behavior disorder (RBD) is characterized by dream enactment and rapid eye movement (REM) sleep without atonia. RBD is closely related to α-synucleinopathy disease, including Parkinson's disease (PD), Lewy body dementia (DLB) and multiple system atrophy (MSA). Many studies have discussed the markers, heredity, cognition, autonomic nervous function of RBD, and the predictive value for neurodegenerative diseases. This article reviews the research progress of early markers and treatments in recent years, and discusses future research directions.

The sense of stigma is common in young and middle-aged diabetic patients, which greatly affects their quality of life. This article reviews the concepts related to stigma, the current status of stigma in young and middle-aged diabetic patients at home and abroad, the influencing factors and their effects on patients, aiming to provide a theoretical basis for the intervention of stigma in young and middle-aged diabetic patients.